Provider Demographics
NPI:1962582049
Name:COLSON, WILLIAM KENNETH (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KENNETH
Last Name:COLSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MARGIE DR STE A
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8934
Mailing Address - Country:US
Mailing Address - Phone:478-971-7701
Mailing Address - Fax:478-971-7705
Practice Address - Street 1:328 MARGIE DR STE A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8934
Practice Address - Country:US
Practice Address - Phone:478-971-7701
Practice Address - Fax:478-971-7705
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0114091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice